666 - Improving the success rate of weaning premature infants to an open crib and maintaining normothermia: a Quality Improvement project.

Friday, April 28, 2023

5:15 PM – 7:15 PM ET

Poster Number: 666
Publication Number: 666.139

Nadia Campbell, The Children’s Medical Center at NYU Winthrop Hospital, Mineola, NY, United States; Ranjith Kamity, NYU Long Island School of Medicine, Mineola, NY, United States; Amrita Nayak, NYU Langone Long Island Hospital, Mineola, NY, United States

Presenting Author(s)

Nadia Campbell, MD (she/her/hers)

Resident Physician
The Children’s Medical Center at NYU Winthrop Hospital
Mineola, New York, United States

Background: One of the criteria to safely discharge an infant from the hospital is the ability to maintain one’s core body temperature in an open crib. Neonates are at increased risk of hypothermia in the first few weeks of life, particularly extremely premature and low birth weight infants. Evaporative heat loss is the major source of thermal instability due to increased body surface area, increased skin permeability, and increased extracellular fluid. Maintaining normothermia depends on a variety of factors, not limited to infant’s weight, gestational age and environmental factors such as room temperature. At NYU Long Island, infants are weaned to an open crib using a thermoregulation protocol. However, due to an increase incidence of failed weans to an open crib, this quality improvement (QI) project was initiated in October 2021.

Objective: The primary objective of this QI project was to reduce the rate of infants failing the transition from an isolette to an open crib by 10% in one year. The global aim was to have safe weaning practices to maintain normothermia in the NICU.

Design/Methods:

A meeting involving numerous key players such as neonatologists, charge nurses, and nursing staff was conducted. A checklist looking at gestational age, weight at time of failure, infant’s body temperature, room temperature, and any intervention done was generated to be completed if an infant failed the wean prior to placing the infant back in the isolette. Environmental factors were assessed by engineering, random audits were conducted, data was analyzed, and trends were assessed.

Results:

Baseline pre-intervention showed 7 infants with failed attempts in the month of September 2021. Post-intervention, there has been a shift in the baseline from 1.4 to 0.6 failed crib attempts per week from Oct 2021 to Dec 2022, representing a 62.2% decrease in the rate overall. Checklist compliance was estimated to be 83.8%. Based on the checklist, 37/42 (85.7%) were < 2500g and 19/42 (45.2%) were < 35 weeks PMA at the time of failure. Random audits conducted by engineering determined an average room temperature of 75°F.

Conclusion(s): By implementing a checklist, we were able to improve the success rate of weaning to an open crib. Strengths of this project included increased awareness regarding the importance of maintaining set room temperature and monitoring the infant’s temperature 24 hours prior to the wean to see if an infant is capable of regulating their body temperature and thus ready to be successfully weaned. Limitations included small sample size, checklist compliance and documentation of interventions done.